Efficacy and Safety of Preoperative Embolization of Meningiomas

Introduction: Preoperative embolization has been employed to enhance the safety and efficacy of surgical resection in hyper vascular meningiomas by reducing intraoperative bleeding and facilitating tumor removal. However, the impact on surgical outcomes, complications, and resection rates requires further evaluation.

Methods: A retrospective review was conducted on 97 patients who underwent meningioma resection at Hospital Juárez de México from 2015 to 2022, of which 24 (24.7%) received preoperative embolization. Data collected included patient demographics, tumor location, embolic material, time to surgery post-embolization, and histopathological findings. Statistical analysis was performed using the Mann-Whitney U test and Pearson's chi-squared test, with a significance level set at p < 0.05.

Results: The median age of patients was 46 years (range: 22-81 years), with a female predominance (71.1%). Convexity meningiomas were most common (28.9%). Embolization primarily targeted the middle meningeal artery (65%), with microspheres used in 62.5% of cases and ethylene-vinyl alcohol (EVOH) in 33.3%. The median interval between embolization and resection was 6.5 days (range: 1-13 days). Post-embolization histology revealed intravascular embolic material in 50% of cases and necrosis in 33.3%. No significant differences were observed in median operative time (320 minutes; p = 0.47) or blood loss (800 mL; p = 0.54) between embolized and non-embolized patients. However, embolized cases showed a significantly higher rate of complete resection per the Simpson grading scale, with fewer cases in the high-risk categories III and IV (p = 0.03).

Conclusion : Preoperative embolization of meningiomas demonstrated a positive impact on resection completeness without significantly altering surgical time or blood loss. Histopathological evidence confirmed reduced vascularity and induced necrosis. These findings support embolization as an effective adjunctive strategy, although careful patient selection based on vascular anatomy and tumor characteristics is essential. Further studies with larger sample sizes and prospective designs are recommended to validate these results.